Healthcare Provider Details

I. General information

NPI: 1447664339
Provider Name (Legal Business Name): UAB FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GOVERNORS DR SW
HUNTSVILLE AL
35801-5123
US

IV. Provider business mailing address

301 GOVERNORS DR SW
HUNTSVILLE AL
35801-5123
US

V. Phone/Fax

Practice location:
  • Phone: 256-551-4631
  • Fax:
Mailing address:
  • Phone: 256-551-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberL3441R
License Number StateAL

VIII. Authorized Official

Name: PRASANNA ALLADA
Title or Position: RESIDENT PHYSICIAN
Credential: MD
Phone: 256-701-1435